What are the reported rates of transition regret among adolescents versus adults in recent studies?
Executive summary
Recent published estimates generally place documented regret after gender‑affirming surgery and medical transition in the low single digits — roughly around 1% in many surgical series and reviews [1] [2] — while adolescent-focused studies typically report low rates of stopping care, reverting identity, or explicit regret often in the 1–9% range [3] [2], though some reports find much higher rates of treatment discontinuation that are not synonymous with regret [4]. Major caveats — high loss to follow‑up, differing definitions of “regret,” cohort differences between older adult samples and today’s adolescents, and short follow‑up windows — make precise comparisons between adolescents and adults unreliable [5] [6] [7].
1. Reported rates among adolescents: low single digits in many studies, but variable
Several recent adolescent cohorts and reviews conclude that explicit regret or stopping care after puberty blockers/hormones is uncommon, with many studies reporting rates below 9% and several in the 1–4% range [3] [8]; a JAMA Pediatrics survey and other recent teen studies describe high satisfaction and low regret among adolescents who received blockers or hormones [9] [10]. At the same time, surveillance‑style prescription reviews show very high continuation among some adolescent groups (for example, 98% continuation in a Dutch cohort after several years for those who started blockers) while other datasets record substantial rates of stopping hormonal therapy among mixed‑age samples, highlighting variability in adolescent findings [7] [2].
2. Reported rates among adults: consistently low in many surgical and long‑term clinic series
Published reviews of adults who underwent gender‑affirming surgery or long‑established clinic protocols report regret rates clustered around or under 1% for surgical regret and generally low percentages for medically treated adults in older cohorts — two large European clinic studies reported 2% or less in some analyses and meta‑analyses of surgical series pooled an ~1% regret rate [1] [7] [2]. These adult figures derive largely from long‑running specialty clinics and surgical follow‑ups where regret has historically been rare in the sampled populations [2] [1].
3. Discontinuation, detransition and regret are distinct and often conflated
Important empirical nuance is repeatedly emphasized in the literature: stopping hormones or “detransitioning” does not automatically equal regret; some who cease treatment do so for access, social pressure, or because the treatment helped them clarify identity rather than because they regretted it [4] [1] [11]. Conversely, studies that rely on clinic return visits, legal record changes, or prescription data can both over‑ and under‑count true regret depending on their definitions and what they measure [5] [2].
4. Methodological limits undermine straightforward adolescent–adult comparisons
Experts warn that cohort differences (older adult samples treated under restrictive protocols versus current adolescents treated under newer models), short follow‑up periods often under the 5–10 years when some effects emerge, and loss to follow‑up rates commonly between 20% and as high as 60% mean regret estimates are at risk of bias and may understate true incidence [6] [5] [4]. Papers reviewing the field explicitly conclude that “accurate” regret or detransition rates are largely unknown because of these recurring limitations [5].
5. Competing narratives, study selection and policy stakes shape how numbers are used
Both proponents and critics of youth transition cite low regret figures to bolster legal and clinical arguments: advocates point to low documented regret and high satisfaction in recent adolescent and adult studies [10] [1], while skeptics highlight gaps, cohort differences, and lost follow‑up to argue that youth regret may be underestimated and that existing adult data aren’t generalizable [6] [5] [7]. Several fact‑checks and investigative reports note the selective use of “1%” versus much larger percentages in public debate and court filings [3] [7].
6. Bottom line — what the recent studies collectively say and do not resolve
Contemporary published data generally show low documented regret after gender‑affirming surgery and low reported regret or treatment cessation in many adolescent studies (most commonly single digits, often near 1%), but the evidence base is heterogeneous and limited by varying definitions, follow‑up durations, and sample selection; therefore, precise, directly comparable regret rates for adolescents versus adults remain uncertain and contested in the literature [1] [3] [5]. Policymaking or clinical decisions that hinge on a single “percent regret” figure should account for these methodological caveats and the fact that discontinuation and detransition are not synonymous with regret [4] [5].